Verrucous plaque on the back of a hand

We report the case of a 44-year-old slaughter-house operator with a skin lesion that had been present for two years on the back of his left hand. The lesion had increased progressively in size despite numerous topical treatments. Physical examination revealed an infiltrated erythematous-violet plaque with a verrucous surface featuring numerous orifices draining purulent material. Histologic study of the lesion disclosed tuberculoid granulomatous infiltrates at the dermoepidermal limit. Presence of Mycobacterium tuberculosis, together with other epidemiologic, clinical, histologic, and immunologic data, permitted a diagnosis of tuberculosis verrucosa cutis to be made. The excellent response of the patient to treatment confirmed this hypothesis. However, polychemotherapy withdrawal was temporarily needed due to analytical abnormalities.

Diffuse whitening of the oral mucosa in a child

We report a healthy 16-year-old Caucasian boy, who consulted us for white, asymptomatic lesions in the mouth. The lesions were stable and had been present for 6 years. On physical examination, there were diffuse white, soft, corrugated plaques involving the buccal and labial mucosa, oral commissures, and floor of the mouth. No other mucosae were affected and there were no skin or nail abnormalities. The histologic findings revealed epidermal hyperplasia with parakeratosis and intracellular edema in the squamous cell layer. No nuclear atypia was observed. A differential diagnosis of three entities is proposed: white sponge nevus, leukoedema, and focal epithelial hyperplasia.

Basal cell carcinoma in a girl after cobalt irradiation to the cranium for acute lymphoblastic leukemia: case report and literature review

A 12-year-old girl had a lesion located on the upper part of the scalp that was clinically interpreted as a melanocytic nevus and corresponded histologically to a basal cell carcinoma. At age 2 years she had been diagnosed as having acute lymphoblastic leukemia L1, for which she was treated with systemic chemotherapy. She also received telecobalt therapy to the whole cranium for prophylaxis of meningeal leukosis. Having rejected other possible causes that can favor the appearance of basal cell carcinoma during childhood (basal cell nevus syndrome, nevus sebaceus, albinism, etc.), we believe that this case should be added to the five previously reported in the literature as basal cell carcinoma developing at an early age in cranial radiation portals with megavoltage radiotherapy. We draw attention to the need to explore radiated areas of skin as part of the long-term follow-up of these patients, and to the advisability of obtaining a biopsy from any persistent lesion in these areas.

'Scléroedème génito-sus-pubien' of the newborn: a forgotten disease?

A 2-month-old boy with an important hardening of the skin in the pubic and genital regions is presented. He was born prematurely at 31 weeks of gestation, and required a respirator during the first 72 h. The analytical explorations and abdominal ultrasound images were normal. Histological study had not shown significant changes. The patient did not receive any treatment and gradually experienced remission. Because of the location and spontaneous regression in a few months, the picture is very similar to the one described by Degos as 'Scléroedème génito-sus-pubien' of the newborn.

Mixed tumors with follicular differentiation: complex neoplasms of the primary epithelial germ

BACKGROUND

Some mixed tumors of the apocrine variety also show characteristics of follicular and/or sebaceous differentiation. This can be explained because of the common embryologic origin of the three structures in the primary epithelial germ of the superficial ectoderm.

METHODS

Twenty specimens of apocrine mixed tumors were studied by conventional microscopy. The specimens were evaluated searching for some features of folliculo-sebaceous differentiation.

RESULTS

Certain features of folliculo-sebaceous differentiation were found in 45% of the samples examined. Additionally, different tumoral architectures were observed, resembling several well-characterized adnexal organoid neoplasms. In some tumors, there were also follicular structures of mesenchymal origin, similar to the dermal hair papilla and the arrector pili muscle.

CONCLUSION

Apocrine mixed tumors of the skin illustrate the ability of pluripotential primordial cells to differentiate in different directions within an individual tumor. Moreover, mixed tumors appear as a compendium of different folliculo-sebaceous neoplasms. We suggest that these proliferations should be interpreted as "complex neoplasms of the primary epithelial germ."

Hereditary hypotrichosis simplex of the scalp

We report on a female aged 13 years, whose scalp hair began to disappear at the age of 9 years, leaving only sparse wispy hairs in the parietal-occipital region. Eyelashes, eyebrows and body hair were unaffected. There were no signs of ectodermal dysplasia on the skin, nails, teeth and eyes nor other congenital abnormalities. The family pedigree showed 15 relatives similarly affected according to an autosomal dominant mode of transmission. Clinical, genetic, histological and ultrastructural aspects led to a diagnosis of hereditary hypotrichosis simplex of the scalp (Toribio-Quiñones type).

Benign cephalic histiocytosis: case report and literature review

A 3-year-old boy had maculopapules on his face and neck since age 6 months. These were yellow-brown, asymptomatic, and clinically similar to flat warts. Histopathologic study revealed a fibrohistiocytic infiltrate in the superficial dermis. Ultrastructurally, comma-shaped bodies, desmosome-like junctions, and coated vesicles were seen; there were no lipid droplets or Birbeck granules. With these data, a diagnosis of benign cephalic histiocytosis was made. Twenty-five cases are reported in the literature: 17 males and 8 females (male:female ratio 2:1). Sixteen patients had lesions on parts of the body other than the head, neck, and shoulders.

Clinical expression of secondary syphilis in a patient with HIV infection

There are increasing reports of unusual clinical features and atypical courses of syphilis in patients with acquired immunodeficiency syndrome. Recently, we had the opportunity to study an HIV-positive female patient with strong manifestations of secondary syphilis. The case is discussed together with the implications of secondary syphilis in her concomitant ocular affliction. Moreover, we comment on the clinico-therapeutic controversies brought about by the association of infection with Treponema pallidum and HIV.

[A topical solution of 40% idoxuridine in dimethyl sulfoxide compared to oral acyclovir in the treatment of herpes zoster. A double-blind multicenter clinical trial]

BACKGROUND

Both topical 40% idoxuridine in dimethylsulfoxide (IDU) and oral acyclovir (ACV) are useful in herpes zoster (HZ). This is the first clinical trial which compares the efficacy of both drugs in the course of the disease and in the prevention of post-herpetic neuralgia (PHN).

METHODS

Patients of both sexes older than 18 years, with a HZ of less than 4 days were selected. Patients with otic or ophthalmic zoster, serious concomitant illness or pregnant or breast-feeding women were excluded. Following a double dummy design, the patients received at random topical IDU and oral placebo, or oral ACV and topical placebo. Topical treatment was applied during 4 days and oral treatment during 7 days. The evolution of the disease (number of individual lesions, evolution of symptoms, use of analgesic drugs and eventual appearance of complications) was controlled on days 0, 2, 4, 6, 8, and weekly until its resolution.

RESULTS

The group of patients treated with IDU (85) showed a better evolution of the disease than those treated with ACV (86) in some of the parameters controlled: day of first and all vesicles drying (p less than 0.05), last day of moderate-intense pain (p less than 0.05), hyperaesthesia (p less than 0.05) and itching (p less than 0.05) and last day of analgesic use (p less than 0.01). The appearance of new vesicles during treatment was lower in the IDU treated group (p less than 0.01). A tendency favouring IDU can be observed in the appearance of PHN.

CONCLUSIONS

In our study topical 40% idoxuridine in DMSO was better than oral acyclovir in 7 of the 14 clinical parameters studied.

Silica and trichloroethylene-induced progressive systemic sclerosis

Several environmental factors and chemicals have been described as being able to induce systemic scleroderma and scleroderma-like diseases. The present work reports 2 male patients with progressive systemic sclerosis and pulmonary silicosis. Both patients had occupational histories of exposure to silica and one of them of handling trichloroethylene as a degreasing agent. The clinical and analytical findings could not be distinguished from those present in idiopathic systemic scleroderma with the exception of interstitial images with calcified hilar lymph nodes in the chest X-ray suggestive of pulmonary silicosis.

Picosecond rotation of small polar fluorophores in the cytosol of sea urchin eggs

A new fluorescence method to measure viscosity in cell cytosol [Fushimi, K., & Verkman, A. S. (1991) J. Cell Biol. 112, 719-725] has been applied to determine fluid-phase viscosity in sea urchin eggs. Freshly harvested eggs from Lytechinus pictus were loaded with the dyes 2,7-bis(2-carboxyethyl)-5-(and-6-)carboxyfluorescein (BCECF), 6-carboxyfluorescein (6CF), fluorescein, or calcein. Fluorescence lifetimes and anisotropy decay were measured in single eggs by multiharmonic, frequency-domain microfluorometry using a 1-2-micron focused laser spot and 25x air objective. In calibration solutions consisting of glycerol in pH 8 buffered sea water, probe lifetime was single exponential and probe rotation was isotropic with a single correlation time which increased linearly with viscosity in the range 1-3.6 cP. In eggs at 22 degrees C, there were single lifetimes (in nanoseconds) of 3.6 (BCECF), 3.4 (6CF), 3.2 (fluorescein), and 3.3 (calcein). Probe rotation in eggs had two components, a fast component (in picoseconds, mean +/- SE, 10-18 eggs) of 568 +/- 39 (BCECF), 311 +/- 21 (6CF), 313 +/- 15 (fluorescein), and 516 +/- 44 (calcein) and a slow component of 10-40 ns. The fractional amplitude of the fast component, corresponding to unbound dye, was 0.72-0.81. Apparent viscosities of fluid-phase cytoplasm (centipoises) given by the four different probes were in good agreement: 2.3 +/- 0.2 (BCECF), 2.1 +/- 0.1 (6CF), 2.5 +/- 0.1 (fluorescein), and 2.3 +/- 0.2 (calcein). The viscosity in cytosol of sea urchin eggs (2.1-2.5 cP) is thus relatively low, yet significantly greater than that of water (1 cP) or cytosol in cultured fibroblasts (1.2-1.4 cP).(ABSTRACT TRUNCATED AT 250 WORDS)

Construction and evaluation of a frequency-domain epifluorescence microscope for lifetime and anisotropy decay measurements in subcellular domains

The measurement of time-resolved fluorescence parameters in living cells provides a powerful approach to study cell structure and dynamics. An epifluorescence microscope was constructed to resolve multi-component fluorescence lifetimes and complex anisotropy decay rapidly in labile biological samples. The excitation source consisted of focused, polarized laser light modulated by an impulse-driven Pockels' cell; parallel acquisition of phase angles and modulation amplitudes at more than 40 frequencies (5-250 MHz) was obtained by multi-harmonic cross-correlation detection. Lifetime decay was measured against standard solutions introduced into the light path proximal to the microscope objective. Anisotropy decay was measured by rotation of a Glan-Thompson polarizer in the emission path. Phase reference light was split from the beam proximal to the microscope. Optical components were selected to avoid depolarization and to optimize fluorescence detection efficiency. The dichoric was replaced by a 1 mm square mirror. Fitting routine statistics were optimized for model discrimination in realistic biological samples. Instrument performance was evaluated using fluorescein in H2O/glycerol and H2O/ethylene glycol mixtures and in Swiss 3T3 fibroblasts in monolayer culture. Objective depolarization effects were evaluated by measurement of anisotropy decay using objectives of different numerical aperture. Lifetime and anisotropy decay measured by microscopy (0.5 micron laser spot) agreed with data obtained by cuvette fluorimetry. New biological applications for time-resolved fluorescence microscopy are discussed.

Incontinentia pigmenti: XXY male with a family history

We report on the case of a male who from the start of life displayed vesicular lesions; on the trunk these were clustered and on the limbs they adopted a linear configuration. After biopsy of one such lesion, the histopathological study was compatible with a diagnosis of incontinentia pigmenti (IP). In the following months, hyperkeratotic lesions appeared which later became pigmented. The mother and other female members of the family also showed different degrees of alteration related to the same disease. The karyotype study showed the existence of 47,XXY (Klinefelter syndrome). The exceptional nature of this case is that although it is the third case reported in the literature of a male affected by incontinentia pigmenti with a previous family history, it is the only one combining this characteristic with the presence of a 47,XXY karyotype.

Subcutaneous fat necrosis of the newborn and idiopathic hypercalcemia

A newborn with important signs of fetal disturbance and respiratory distress and respiratory distress developed plaques on both buttocks 14 days after birth, with the clinical and histological characteristics of subcutaneous fat necrosis of the newborn. Fifteen days after the onset of the cutaneous signs, a discrete degree of hypercalcemia was detected. Its outcome was favorable due to the early establishment of a diet rich in medium-chain triglycerides and devoid of calcium and vitamin D. Sixteen cases of idiopathic hypercalcemia in newborn with subcutaneous fat necrosis have been reported of which 3 died. Serial serum calcium determinations should be made in such infants and they should be observed closely for signs and symptoms of hypercalcemia.

Our experience in the surgical treatment of cancer and precancerous lesions of the lower lip

We report on 279 patients with cancer and precancerous conditions of the lower lip who have been surgically treated. Cure rates and cosmetic results are evaluated in relation to the different surgical techniques employed. The types of tumors are statistically analyzed and discussed.

Mucoid cysts of the fingers. Differential diagnosis, ultrastructure, and surgical treatment

The title "digital mucoid cyst" is generic and encompasses cutaneous myxomas, which are focal intradermic mucinoses that are at times cystic, and ganglia, which are subcutaneous teno-arthro-synovial "hernias." A large myxoma over the second and third phalanges of the middle finger of the left hand is reported that caused progressive functional incapacity. It was managed by surgery, the technique of which is described. The need to differentiate cutaneous myxomas from ganglia is emphasized because the treatment of them is different.

Effect of indomethacin on the cyclic AMP-dependent protein kinase

Indomethacin inhibited cyclic AMP-dependent protein kinase activity in small intestine in in vivo experiments. An inverse pattern of variation was exhibited by acetyl salicylic acid, eterylate and benorylate, acetyl-p-amino-phenol being inactive. Indomethacin, acetyl salicylic acid, eterylate and benorylate increased the protein kinase activity in liver, lung and heart after in vivo administration. The in vivo effect of indomethacin was confirmed by in vitro experiments with small intestine and heart protein kinases. These results support the concept that indomethacin can affect protein kinase activity in a tissue-specific way.